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TOTAL CARE RX, INC.
DSH330055Q NEWYORK-PRESBYTERIAN / QUEENS
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Covered Entity Details
Entity Name
NEWYORK-PRESBYTERIAN / QUEENS
Subdivision Name
NYP/Queens Trude Weishaupt Memorial Satellite Dialysis Center
Type
Disproportionate Share Hospital
340B ID
DSH330055Q
Entity Address
59-28 174th Street
Fresh Meadows, NY 11365
Medicare Provider Number
330055
Outpatient Facility Provider Number
333547
Participating Start Date
1/1/2014
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
TOTAL CARE RX, INC.
Pharmacy Address
WORLD'S FAIR PHARMACY
22310 UNION TPKE
OAKLAND GARDENS, NY 11364-3645
Pharmacy Comments
Contract Details
Approval Date
1/11/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kevin Ward, Senior VP FOR FINANCE
(718) 670-1476
Contract Pharmacy Representative
Totalcarerx, inc
William Donnelly, Vice President
(718) 762-7111
Signed By Date
1/11/2019
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